One of the things I read about last
week was of a 32-year old man who sadly died while on his way to his honeymoon.
He had eaten his meal on the plane, and died soon after from what appears to
have been an allergic reaction to broad beans. Whilst I understand that it is possible to
have an allergy to many things, I hadn’t realised that hundreds of millions of
people worldwide are allergic to the humble broad bean. The allergy is caused
by a genetic defect, resulting in a person lacking the enzyme G6PD (glucose 6
phosphate dehydrogenase). It’s an enzyme involved in many of our vital body
processes, and in particular for maintaining the integrity of red blood cells.
It is a hereditary disorder, common amongst those from Greece, Italy, Spain and
the Middle East. Most people with this deficiency are men.
The Greek mathematician and
philosopher Pythagoras wouldn’t eat broad beans. His followers, Pythagoreans, lived
communally and were vegetarians, but also avoided eating the bean also known as
the ‘fava bean’. However, this was not because they understood the allergic
properties of the bean, but because they believed broad beans were a
supernatural symbol of death. They also
believed it was sinful to eat beans. In the context of the death of the man on
the plane from eating broad beans, it was probably an astute belief to hold.
The broad bean was first brought to Europe in 1492, and it was one the first
cultivated crops in history. It was an important source of protein for many.
Many years later Aristotle,
(often considered the Father of Western Philosophy) thought that Pythagoreans
avoided bean as a form of political protest against democracy. In those days
coloured beans were used to cast votes in elections. Pythagoreans decried
democracy in favour of oligarchy. And talking of which, I read a story last
week of Genghis Can’t signing a ‘Right to Try Act’ for terminally ill patients.
It was a kind of strange story, as there are already 40 or the 50 states in the
US who have enacted such a bill. The bill gives those with a life shortening
condition who are terminally ill the right to try experimental treatments not
approved by the US government. Interestingly, although the bill is entitled
right to try, it does not mandate the pharmaceutical industry to make unapproved
drugs available to patients asking for them.
This new bill protects doctors
and pharmaceutical companies from any legal risks of allowing unapproved treatments
unless they intentionally harm a patient. For me that is the rub. All drugs have to go
through a rigorous process of clinical trials. This is a process that can take
many years, typically ten to 15 years. There are good reasons for this, and the
prime one is not to do harm to others; which, as a nurse of
many years’ experience, is a duty I hold very dear. Whilst I’ve accepted I have
a duty to try and help those patients I care for, I also recognise that in
doing so, I should avoid causing any harm to them. Not causing patients any
harm has almost always outweighed my sense of duty to try and help. It’s a balance
that most health care professionals face every day in practice.
Our understanding of the
underlying evidence and science underpinning most health care interventions is
light years away from the Pythagoreans and their reasoning for avoiding broad
beans. Allowing access to experimental and unapproved drugs not only means patients
lose the protection of governmental approval, but also interrupt the process of
developing new drugs and the establishment of an underpinning evidence base of ‘effectiveness
versus harm’. This is why clinical trials are difficult to establish, run and successfully
bring new drugs to the market. It’s a balance between protecting the many versus
the exercising of choice by the individual.
I feel blessed that I don’t live
with a life-shortening condition. With very few exceptions, those people I have
known with a terminal illness have all sadly died relatively soon after receiving
their diagnosis. So of course I don’t know what decisions I might want to
consider taking if I found myself in that position. That said, the news report
made me stop and think about the ethical issues of allowing people access to
unapproved drugs, however the desire to prolong life might be. I found the
issue troubling.
What I find less troubling is my
love of ‘Phaseolus vulgaris’. That’s the posh name for haricot beans, from
which most baked beans are made. I could eat them every day, on toast, with meals
such as asparagus and pea risotto, or just cold out of the can. Pythagoras is probably
turning in his grave! But there again he also said: ‘the square of the
hypotenuse is equal to the sum of the squares of the other two sides’ –
something drummed in to me as a schoolchild, but which is a piece of knowledge
I have never felt the need to draw upon.
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